Abu Hijleh Amin, Khalid Filza, Abdalbari Karim, Yousaf Shahzad
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE.
General Surgery, Mediclinic Parkview Hospital, Dubai, ARE.
Cureus. 2025 Apr 8;17(4):e81875. doi: 10.7759/cureus.81875. eCollection 2025 Apr.
Biliary colic, characterized by intermittent right upper quadrant (RUQ) abdominal pain, is a common clinical presentation worldwide. The most frequent underlying causes include acute or chronic cholecystitis and cholelithiasis. In cases where ultrasound findings are unremarkable, patients sometimes undergo a hepatobiliary iminodiacetic acid (HIDA) scan to evaluate gallbladder and biliary tree function. Traditionally, the results are categorized into two outcomes based on the gallbladder ejection fraction (GBEF): biliary dyskinesia or normal function. Biliary dyskinesia, or hypokinesia, is characterized by reduced gallbladder ejection fraction (GBEF), whereas biliary hyperkinesia involves abnormally elevated GBEF, reflecting excessive contractility and remaining poorly understood. We present a case of a 55-year-old female with functional gallbladder disease manifesting as intermittent biliary colic. Initial investigations, including ultrasound and gastroscopy, were unremarkable. However, a HIDA scan revealed an elevated GBEF of 85% at 1 hour, consistent with biliary hyperkinesia. The patient experienced reproducible RUQ pain 40 minutes after consuming a fatty meal. She underwent laparoscopic cholecystectomy, which resulted in complete resolution of her symptoms. A literature review highlights that many patients with normal imaging findings are diagnosed with biliary dyskinesia based on abnormal GBEF measurements from HIDA scans. While biliary hypokinesia is more commonly recognized, biliary hyperkinesia remains a rare entity. Surgical intervention, particularly laparoscopic cholecystectomy, has been shown to provide significant symptomatic relief in these patients. In conclusion, many patients with biliary colic remain undiagnosed or are managed medically due to a lack of understanding of the underlying pathophysiology or insufficient diagnostic tools. As demonstrated in this case, we propose that patients with normal baseline investigations for biliary colic should undergo further evaluation, including HIDA scans, to rule out functional gallbladder disorders such as hypokinesia or hyperkinesia. Surgical treatment should be considered as a viable option for symptom relief, particularly in cases where pain causes significant distress and impairs quality of life.
胆绞痛以间歇性右上腹（RUQ）腹痛为特征，是全球常见的临床表现。最常见的潜在病因包括急性或慢性胆囊炎和胆结石。在超声检查结果不明显的情况下，患者有时会接受肝胆亚氨基二乙酸（HIDA）扫描以评估胆囊和胆管树功能。传统上，根据胆囊射血分数（GBEF）将结果分为两种：胆囊运动障碍或功能正常。胆囊运动障碍或运动功能减退的特征是胆囊射血分数（GBEF）降低，而胆囊运动功能亢进则涉及GBEF异常升高，反映出过度收缩，目前对此仍了解不足。我们报告一例55岁女性功能性胆囊疾病，表现为间歇性胆绞痛。包括超声和胃镜检查在内的初步检查均无异常。然而，HIDA扫描显示1小时时GBEF升高至85%，符合胆囊运动功能亢进。患者在进食高脂肪餐后40分钟出现可重复性的右上腹疼痛。她接受了腹腔镜胆囊切除术，症状完全缓解。文献综述强调，许多影像学检查结果正常的患者基于HIDA扫描中GBEF测量异常被诊断为胆囊运动障碍。虽然胆囊运动功能减退更常见，但胆囊运动功能亢进仍然是一种罕见的情况。手术干预，特别是腹腔镜胆囊切除术，已被证明能显著缓解这些患者的症状。总之，由于对潜在病理生理学缺乏了解或诊断工具不足，许多胆绞痛患者仍未得到诊断或接受药物治疗。如本病例所示，我们建议对胆绞痛基线检查正常的患者应进行进一步评估，包括HIDA扫描，以排除胆囊运动功能减退或亢进等功能性胆囊疾病。手术治疗应被视为缓解症状的可行选择，特别是在疼痛导致严重困扰并损害生活质量的情况下。
